Fighting poverty through alcohol misuse prevention in Malawi

Report
Fighting poverty through alcohol misuse
prevention in Malawi
A STUDY OF ALCOHOL USE AMONG THE
ADULT POPULATION IN MALAWI
Research Group
SINTEF Global Health and Welfare
Professor Arne Eide, Stine Hellum Braathen, Gloria Azalde
University of Malawi – Centre for Social Research
Dr. Alister Munthali and Mr Massy Chiocha
Hedmark University College
Assistant Professor Erik Hoel
University of Oslo
Associate Professor Henrik Natvig
National Statistical Office
Mr. Jameson Ndawala
Reference group
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FORUT, Norway
National Statistical Office (NSO), Malawi
NGO Gender Coordination Network, Malawi
Inter-Ministerial Committee on Drug Control (IMCDC), Malawi
Ministry of Health, Malawi
Drug Fight Malawi
Malawi Alcohol Policy Alliance
Malawi Girl Guides Association
Ministry of Home Affairs and Internal Security, Malawi
Task Force for a National Alcohol Policy, Malawi
The Norwegian Church Aid, Malawi
The Church and Society CCAP, Nkhoma Synod, Malawi
WHO Country Office (Malawi)
WHO Regional Office for Africa
The ALMA project
The aim of the project is to meet Malawian policymakers' and stakeholders'
expressed needs for empirical evidence that can be used in the development
of national alcohol policies. Our main objective is to document, describe and
explore patterns of alcohol use in the Malawian population.
Specific objectives:
• To study the prevalence of alcohol consumption and misuse in Malawi
through a broad based survey, and to use this data to explore (WP2)
– the association between alcohol use/misuse and different dimensions of
poverty (i.e. living standard, health and empowerment)
– the association between alcohol use/misuse and gender
– The general drinking pattern among adult population in Malawi
• To explore people's opinions and experiences of current and future policy
and interventions related to alcohol use (WP3)
Methodology: Quantitative
• A nationally representative survey was conducted among persons
aged 18+.
• Sample size was determined using a standard formula, 107
enumeration areas (EAs) were randomly selected.
• Screening questionnaire was administered to 31.676 households in
these 107 EAs - equals a total of 63.352 individuals.
• After the screening, 20 households were randomly selected among
those households where either the husband or spouse had been
drinking past 12 months.
• A total of 1795 households were included in the study. Drinkers;
1776 males and 156 females.
• Both husband and wife were interviewed separately using an
almost identical questionnaire
Methodology-Qualitative
The qualitative study aimed at exploring people’s opinions on
current and future policy and interventions related to alcohol. This
included a review of literature and conducting interviews with:
Informant category/ Region
NR
CR
SR
Traditional Authorities (TA/ Village Headmen/ Group
Village Headmen)
Community members (CM)
Workers/ owners of formal alcohol outlets (Bar/
Nightclub)
Brewers/ distillers/ sellers of informal alcohol
Police (official and community based)
School (teachers/headmasters)
Official offices
Non-government organisations (NGOs)
Traditional healers (TH)
Health providers (hospital/ clinic)
Religious leaders
Psychiatric wards
Total
3
2
3
4
2
4
4
2
2
3
2
3
1
1
1
2
1
3
2
1
1
1
2
2
2
2
2
1
1
1
1
2
23
22
19
National
level
1
1
1
2
5
Findings – national survey
• Among persons aged 18+ year, 14.5% reported
to have drunk alcohol in the 12 months
preceding the survey.
• Among heads and spouses in the households
sampled, 27.3% of the men and 1.6% of the
women reported drinking the last 12 months.
Findings
• The proportion of persons who reported any
alcohol use in the last 12 months: Litres 100%
alcohol per year (n = 1776 men, 156 women)
• 8.5% of the females who reported drinking drank
on average 1.6 liters of pure 100% alcohol in a
year. This is equivalent to approximately 35 liters
of Carlsberg beer with 4.5% alcohol content.
• 98.3% of the males who reported drinking drank
on average 8.1 liters of pure 100% alcohol in a
year. This is the same as approximately 175 liters
of Carlsberg beer with 4.5% alcohol content.
Comparing alcohol types; 1776 men, 156 women
Alcohol use by religious affiliation and gender
Alcohol use by religious affiliation and gender
12
Alcohol use in litres/year
10
8
6
4
Males
Females
2
0
Alcohol use by
gender and age
groups
Drinking by main occupation
Occupation
N
Men
Mean No.
Litres
Men (NS)
N
women
Mean No. Of
Litres
Women (NS)
Employed (White collar)
135
9.11
9
0.97
Employed (Blue collar)
315
7.91
22
1.62
Self employed/business
437
8.04
30
0.99
Farmer
843
7.25
86
1.66
1
17.06
0
-
Retired
17
8.31
1
0.09
Receiving grants
20
5.33
5
2.67
Unemployed
12
17.58
1
4.62
1780
7.76
154
1.52
Homemaker
Total
Alcohol use (litres/year)
Alcohol use by socio-economic status (SES)
Alcohol use (litres/year)
Alcohol use (yearly) by dietary diversity in households
Alcohol use (litres/year)
Alcohol use (yearly) by level of education
Alcohol use (litres/year)
Alcohol use (yearly) by physical health
Alcohol use (litres/year)
Alcohol use (yearly) by mental health
Conclusion
• Less than one in three adult males drank alcohol
12 months prior to the survey.
• A very small percentage of women drink alcohol.
• Alcohol use was more common in central and
northern Malawi as compared to the southern
region.
• Drinkers from Southern Malawi drank more than
alcohol users in the Central and Northern Malawi.
Conclusion
• There are no support for saying that alcohol
use/abuse leads to poverty. However, the
consequences are much more seriously for
poor people drinking alcohol.
Findings – Qualitative study
• Most informants talked about the cheap and
commonly available sachets as a major challenge.
• Most informants suggested banning of sachets mostly
due to its accessible pricing and availability (size of bag
and amount of alcohol) in relation to children.
• Major producers of alcohol also tried to make satchets
to compete with other producers of satchets but
proces could not compare.
• Sachets may or may not be banned, but they are
produced and very available.
• In the few years sachets have been available,
informants tell us that children’s drinking patterns have
changed dramatically
Findings
• Opening hours formal alcohol sales
– Current opening hours varies despite type of
license
– Many suggest stricter regulation with regards to
opening hours, like for example opening later
(after working hours) and closing earlier at night
• Age is difficult to enforce in Malawi – even
children go and buy beer?
Findings
• Informal alcohol in relation to content and selling
places
– Informal alcohol can vary in alcohol percentage and
content from brewer to brewer
– Difficult to control production because it is produced
in and sold from homes
– Even our law enforcers go and drink there including
community police.
– Difficult to control opening hours
– Kachasu is not included in any legal documents may
be some bylaws?
Findings
• Understanding of harmful use
• People’s understanding of what is harmful can be questioned
• Drinking in itself regardless of amount is not seen as harmful
• Alcohol is considered harmful in the following situations:
– Drinking without eating, drinking children, gender based violence,
use of bad language, fights, traffic accidents and more
• People do not see the connection between alcohol use and
poverty
– There seems to be poor understanding of consequences
of alcohol on living conditions among children, youth
(and adults)
Findings
• Implementing of laws and regulations
– Shortage of resources to implement, regulate and
enforce laws (police, city and district assemblies)
– Current fines to not deter illegal behavior
– Knowledge of laws seems to be poor
• «They cannot punish people for breaking laws they
don’t know about»
Findings
• Some suggestions from the communities
– Many state that people drink because they have
nothing to do and have no work, several suggest
to put people into activity in the community,
– Loans to to informal brewers to start alternative
businesses
– Loans to community members to ease poverty
Conclusions
• Strengthening communities will ensure
positive role models
– Empowering Chiefs, Village headmen and
Traditional Authorities seems to be the key
– Empowering parents
• Increase fines to change behaviour
• ALMA report: www.sintef.no/alma

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